global noncommunicable disease network

Forum Report

AUGUST 2011

Global Noncommunicable Disease Network (NCDnet)

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FOREWORD

The decision by the United Nations General Assembly to hold a high-level meeting on noncommunicable diseases (NCDs) in September 2011 represents a significant milestone and opportunity. It was a result achieved only through the collective action of many different stakeholders over many years. As part of the build-up to the UN high-level meeting, the World Health Organization was invited to undertake regional consultations to provide an input into the preparations for the high-level meeting as well as the meeting itself. By early April 2001, all six WHO regions had completed their consultations, and informal dialogues with NGOs and the private sector were undertaken in November 2010. Capitalizing on the opportunity presented by the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control in Moscow on 28-29 April, the World Health Organization decided to convene a multi-stakeholder Forum on NCDs the day before, to help ensure that the perspectives of a range of important stakeholders were able to inform the discussions at the Ministerial Conference. The WHO Global Forum: Addressing the challenge of noncommunicable diseases was an important new development, building on the consultations undertaken previously and bringing together the full range of interested stakeholders to share and listen to each other's views and experiences. I am pleased to provide this report on the WHO Global Forum, which I hope does justice to the richness and breadth of the discussion held on 27 April in Moscow. The Report and other Forum documents are available on the WHO website.1 Finally, I wish to thank the Government of the Russian Federation for the financial and practical support that made the Forum possible. WHO looks forward to continuing to work with all stakeholders both ahead of and beyond the UN high-level meeting in September to effectively address the global health challenge of NCDs.

Dr Ala Alwan Assistant Director-General Noncommunicable diseases and mental health World Health Organization

1 http://www.who.int/nmh/events/global_forum_ncd/en/

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FORUM REPORT

I. INTRODUCTION

Noncommunicable diseases are increasingly recognized as a major global health challenge that requires a response by all sectors of society. The decision by the United Nations General Assembly to convene a high-level meeting (HLM) on noncommunicable diseases in September 2011, with the participation of Heads of State and Government, presents a unique opportunity for the full range of stakeholders to shape that response. The WHO Global Forum: Addressing the Challenge of Noncommunicable Diseases was convened to bring together a wide group of stakeholders to share views and experiences to date on the challenges and opportunities in noncommunicable disease prevention and control. The Forum set out to raise awareness of the September 2011 HLM on noncommunicable diseases, and to provide input into the preparation for the HLM as well as discussions on noncommunicable diseases at the sixty-fourth World Health Assembly in May 2011. In contrast to previous consultations and dialogues convened by WHO on noncommunicable diseases, the Forum brought together the different stakeholders in a format that allowed for discussion and interaction rather than a two way dialogue between WHO and individual stakeholder groups. The intention was to create an opportunity for the different groups to listen and respond to each other to allow WHO to canvass a wider and richer range of views to inform its work on noncommunicable diseases. The Forum was held immediately prior to the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Diseases in Moscow on 28 and 29 April 2011. This provided an opportunity for the outcomes of the Forum to directly inform the Ministerial Conference and its outcomes. In order to provide access to the Forum for people unable to attend in person, the Forum plenary sessions were webcast live and can still be viewed online.2

2Webcasts of the WHO Global Forum plenary sessions are available at: http://www.who.int/nmh/events/global_forum_ncd/mediacentre/en/

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II. OBJECTIVES FOR THE GLOBAL FORUM

The objectives of the Forum were to:

• Provide an opportunity for a wide range of stakeholders to discuss and share perspectives on the prevention and control of noncommunicable diseases (NCDs)

• Understand expectations, roles and contributions of the different stakeholders in support of the September 2011 UN High-level Meeting (HLM) on NCDs and its expected outcomes, as well as activities post the HLM.

• Update knowledge and share experience on progress in addressing NCDs including through implementing the Action Plan for the Global Strategy for the Prevention and Control of NCDs.

• Promote ways of accelerating the implementation of actions for international and national partners under each objective of the Action Plan.

• Mobilize a broader base of stakeholders in support of NCD prevention and control, in particular in developing countries.

III. PROPOSED DELIVERABLES OF THE GLOBAL FORUM

It was intended that the Global Forum would yield three deliverables: • A short report to be presented during the World Health Assembly in May 2011 to

inform Member States of the conclusions of the Forum and support their preparations for the HLM

• Lessons learnt in organizing multi-stakeholder discussion forums • A statement to be delivered to the Moscow Ministerial Meeting representing key

perspectives from the stakeholders.

IV. FORUM PARTICIPANTS

In keeping with the intent of the Forum participants were invited from the following stakeholder groups:

− Civil Society and nongovernment organizations − Faith-based organizations − Patient and consumer organizations − Private sector representative organizations − Food and non-alcoholic beverage and alcoholic beverage representative

organizations − WHO Collaborating Centres − Researchers and research bodies − Academia − Member States.

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The list of those participants who had registered online by 25 April 2011 is attached as Appendix 2. A number of other participants from Member States registered onsite for the Forum: these were members of the delegations for the subsequent Ministerial Conference, who had registered online for that event.

V. PROGRAMME FOR THE GLOBAL FORUM

The programme for the Forum was designed to provide a range of opportunities for participants to engage and contribute actively. It included a short opening plenary session, concurrent sessions to identify outcomes sought from the HLM on noncommunicable diseases, a plenary report- back on the concurrent sessions, and a final plenary session to consolidate the key messages and findings from the day. The final annotated agenda is attached as Appendix 1.3 VI. OPENING PLENARY SESSION The purpose of the opening plenary session was for WHO and the Russian Federation to welcome participants, outline the purpose and format of the WHO Global Forum and set the scene for the day. The WHO Director-General, Margaret Chan, opened proceedings and welcomed participants to the Forum. In her opening remarks (appendix 2),4 the Director-General emphasized the scale of the challenge presented by noncommunicable diseases (NCDs) and the need for the response to go beyond the health sector. Many of the drivers of NCDs are driven by strong commercial interests, over which the health sector has no direct control. Dr Chan noted that the private sector, including the food industry, needs to be involved in solving the problems, although was emphatic that there is not place at the table for the tobacco industry. Some industry actors have begun to take action, but there is a need for more action by a wider range of actors. In closing, Dr Chan questioned whether there is a net gain if the benefits of modernization and economic growth are cancelled out by the costs, like medical bills, lost productivity, and premature death, of a preventable disease. She concluded that sophisticated and costly medicines, devices, and technologies will not be able to save the situation and that only smart, farsighted policies can do this. The Deputy Minister of Health and Social Development of the Russian Federation, Veronika Skvortsova, then addressed the gathering and welcomed participants on behalf of the Russian Federation. She noted that both communicable and noncommunicable diseases

3 The annotated agenda for the WHO Global Forum is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/agenda_20110427.pdf 4 The WHO Director-General's opening remarks are available at: http://www.who.int/dg/speeches/2011/global_forum_ncd_20110427/en/index.html

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are now a threat to development and national economies. As NCDs are the leading causes of morbidity and mortality, governments need to ensure their policies and programmes address their prevention and control. Dr Skvortsova emphasized the importance of healthy food, as well as tobacco control and effective measures to reduce harmful alcohol consumption. Civil Society and the private sector are essential actors, including the food and pharmaceutical industries. She noted that all those present were there because of their concern and commitment to addressing noncommunicable diseases. Dr Skvortsova commended participants on their commitment and participation in the Forum.

Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health, WHO, presented new data from the WHO Global Status Report on NCDs.5 These data show that NCDs are the biggest cause of death worldwide and that nine out of ten deaths from NCDs before the age of 60 occur in developing countries. He outlined the process leading to the UN high-level meeting on NCDs in New York on 19-20 September 2011, and highlighted the place of the WHO Global Forum in that process. Dr Alwan noted that the Forum uniquely brings together all the relevant stakeholders in a format that allows for genuine interaction and discussion. He then summarized achievements in the past three years, the challenges still to be met, as well as the opportunities ahead including both the Forum and the high-level meeting itself in September 2011.6

VII. CONCURRENT SESSIONS The purpose of each of the concurrent sessions was to focus on the contribution of a key stakeholder group to the prevention and control of NCDs, identifying: 1. the key challenges for NCD prevention and control, as they relate to the group or issue 2. the outcomes they wish to see from the Moscow Ministerial Conference and the

September High Level Meeting 3. the commitments/priorities identified as necessary to accelerate progress in addressing

NCDs. The proposed format was a brief (10 minute) presentation to provide an overview of the issues, with two or three brief responses (5 minutes) followed by facilitated discussion on the three key questions. Session rapporteurs collated and reported back the conclusions and key findings from the discussions ready for reporting back in the post-lunch plenary session.

5 The WHO Global Status Report 2010 is available at: http://www.who.int/nmh/publications/ncd_report2010/en/index.html 6 The presentation of the WHO Assistant Director-General for Noncommunicable Diseases and Mental Health is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/opening_plenary_alwan.pdf

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Concurrent Session 1: Private sector including pharma, insurance, e-health, sportDr Eduardo Pisani, International Federation of Pharmaceutical Manufacturers Association, chaired this session. An opening presentation on the "Key roles, challenges, expected outcomes, commitments and priorities" for the private sector was made.7 The following is a summary of the discussions. A. Challenges The private sector is not always trusted, although it needs to be part of the solution – it could do better at making the case for its involvement by "saying what it can do not what it wants". It will help if the private sector 'offering' is consolidated, with greater clarity on the drivers, including the nature of and incentives for Public-Private Partnerships. Universal access to essential medicines is important but complex – issues of profitability, distribution and regulatory regimes need to be considered. Likewise, the private sector needs clarity on what is meant by universal access to essential medicines. B. Outcomes The private sector would like governments, agencies and NGOs to view them as key partners in addressing NCD prevention and control. It is important for NCD prevention and control to be elevated to the highest leadership level, including beyond the health sector. Governments can create incentives to foster a research and development environment, not just for pharmaceuticals but also for other private sector goods and services, e.g. information systems. C. Commitments and priorities The private sector is committed to playing a full part in Civil Society's response to NCDs, including in sectors beyond health. Workplace wellness programmes should be scaled up as these present an important opportunity to reach a large proportion of the population. Finally, the various private sector players can commit to undertaking research and development activities to support NCD prevention and control. Concurrent Session 2: Food, non-alcoholic beverage & alcoholic beverage industries

This concurrent session was chaired by Mr Jorge Casimiro, representing the International Food and Beverage Alliance (IFBA). An opening presentation was made on the commitments made by the IFBA companies and the progress made in achieving them.8 Many companies are already working on product composition by reducing salt, fat and sugars, while others are providing enhanced information, and cutting down marketing of unhealthy products to kids.

7 The presentation of Dr Raynaud is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_1_private_sector_raynaud.pdf 8 The presentation of Mrs Voûte is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_2_ifba_voute.pdf

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Responses to the presentation focused on food security; the need to recruit additional companies including small and medium enterprises; the opportunity presented by multi-stakeholder forums like the EU platform on diet and physical activity; and the specific partnership on physical activity in Russia that involves government, the private sector and communities. The following is a summary of the discussions. Following a wide-ranging and spirited discussion, the rapporteur, Jeff Sturchio from the Global Health Council summarized the key messages, after which there was further discussion to ensure these reflected the issues canvassed during the session. While the role of the alcohol beverage industry was intended to be part of the session, this did not come up during the discussion. A. Challenges There remains a clear tension between the different viewpoints on appropriate use of regulation to achieve improved outcomes – are the voluntary commitments made by IFBA sufficient, or is greater government regulation needed. Likewise, there are differing views on whether the benefits of public-private partnerships outweigh the potential risks. Industry needs to be clearer on exactly what they are prepared to do and whether these actions will in fact contribute to achieving international and national policy objectives. B. Outcomes Further opportunities for multi-stakeholder dialogue are important, as will be independent measurement and reporting of progress against commitments. Ways need to be found to improve trust among the stakeholders that can then lead to action to address NCD prevention and control. C. Commitments and priorities An important next step would be for greater transparency on food industry commitments and accountability mechanisms that include clear targets and timelines. Environments that are conducive to 'healthy choices' are vital, and the industry has an important role to play in shaping those environments. Concurrent Session 3: Health professionals and health services Dr David Kerr from the European Society for Medical Oncology chaired this session. presentation to outline the health care infrastructure and work force to address the NCD burden was made. The largely untapped potential for health care workers to engage in health promotion and diseases prevention was highlighted, as well as the gap in the provision of the most cost-effective treatment services.9 The following is a summary of the discussion.

9 The presentation of Dr Cazap is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_3_health_professionals_cazap.pdf

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A. Challenges The global shortage of health workers is a major challenge that is compounded by their inequitable distribution in terms of geography, profession and training. Integration of care pathways across different vertical programs will be fundamental, with a need to shift the balance to primary and community care. There is a need to enhance the role of both health professionals and non-professional community workers in NCD prevention and control. B. Outcomes Determined efforts need to be made to integrate NCDs into national health and development plans and health service delivery across the continuum of care. This will require a systematic approach to strengthening health system capacity and capability to deal with NCDs. There needs to be greater investment in education and training, as well as incentives for performance and retention. A clear role for the international community should be identified so that it supports country-led initiatives. Cost-effective packages for NCD care should be identified, as should the technical and financial resources to deliver them. C. Commitments and priorities The health sector and health professionals should commit to making available and using existing platforms and alliances for exchanging knowledge and best practices, eg patient and professional societies. Health professionals and their organizations have an important role to play in ensuring that Heads of State and government participate in the September high-level meeting. Concurrent session 4 Civil Society including faith-based and consumer organizations The President of the International Union Against Tuberculosis and Lung Disease, Dr Bertie Squire chaired this session. A presentation focusing on advocacy for cancer and NCD prevention and control was made, emphasizing the need to involve patients and people who have been affected by these diseases.10 Their stories are a powerful advocacy tool to generate political action. Three themes were reiterated:

1. The paradox of NCDs – a huge health and economic burden that doesn't have the attention it deserves

2. The need for a unified response 'galvanize the crowd into a community' 3. The specific role of civil society and where it uniquely can add value.

A broad range of organizations was present for the session and contributed to the session. The following is a summary of the discussion.

10 The presentation of Mr Ulman is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_4_civil_society_ulman.pdf

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A. Challenges Four broad challenges were identified. First, 'technical considerations, including: the absence of mental health from the current NCD priorities; the branding of NCDs; and the fact that risk factors for some NCDs are in fact infectious in nature. Greater clarity on these issues will be helpful as will specific guidance on strengthening health systems. The second was the need for governments to fully understand and commit to the NCDs agenda and to commit resources to dealing with NCD prevention and control. Third were the health systems challenges, including access to and affordability of services. Finally, commercial interests and how they interact in this space was identified as a challenge, but also an opportunity. B. Outcomes The first desirable outcome identified in this concurrent session was funding and resources for NCD prevention and control; these include indigenous sources including taxes and innovative means as well as potentially development funding. Second was the structural response, including appropriate governance and leadership arrangements and mobilizing partnerships with the full range of stakeholders such as patient and community groups. There is an opportunity to harness the new social media to engage a wider community in support of NCD prevention and control. The third outcome being called for was time-based indicators and targets and a mechanism for monitoring them. Fourth was 'normative clarity' around the relationships with communicable diseases and the health systems response to provide more specific guidance to governments on how to do this. Finally, attitudinal change is needed in the public health community to ensure appropriate engagement with the private sector. Consumers also need to be supported to change their attitudes towards the risk factors for NCDs. C. Commitments and priorities There was an exciting discussion that elicited a range of significant commitments from those present including professional bodies, faith-based organizations, NGOs. A number of examples were provided of specific commitments that covered awareness raising, helping to identify targets, mobilizing membership networks, developing training programs on NCDs for leaders, capacity building, strengthening the consumer response to NCDs, integrating NCD prevention and treatment into existing services such as maternal and child health, service development and mobilizing political leadership. It was noted that the role of Civil Society organizations is to assist and support governments and States, which have the primary responsibility for NCD prevention and control.

Concurrent session 5 Researchers and academia

Dr Abdallah Daar, Chair of the Global Alliance for Chronic Diseases, chaired this session. The main presentation reminded participants that we have sufficient research evidence to act decisively on NCDs, but that we need better research evidence on how to intervene more

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effectively.11 The current research challenges and proposed responses for NCD policy and practice were reviewed.

The following is a summary of the discussion.

A. Challenges Much is known about the size and causes of the problem, but more is needed on the details in particular country and region specific data – this requires surveillance to guide investment by governments. There is improving evidence from implementation research that supports translating knowledge into action, but this is currently underfunded and is a high priority for further investment. Likewise, we are in the 'infancy' of integrating the science into policy action, e.g. the WHO Framework Convention on Tobacco Control (FCTC) is only partially implemented despite wide ratification. More information is needed on what is modifiable in different countries, as this is strongly related to social and cultural influences. While health services 'own' the diseases, they don't own the causes as these are environmental and social. Thus, there is a problem with the 'ownership' of prevention: effective prevention is effectively invisible. Research needs to also look at intergenerational effects ie fetal and newborn development - and research into preventing prolonged morbidity, which is a big driver of costs. B. Outcomes A desirable outcome is a wider commitment and investment in the nascent international collaboration for funding of culturally-specific research, which has an initial tranche of funding available for implementation research. Further investment in surveillance will be critical, especially to strengthen surveillance in developing countries. A better understanding of the size and epidemic nature of the problem, ie that it is reversible will be crucial to ensure that the necessary investment is made now to prevent a huge and costly potential problem The 'knowledge pool' is bigger than just the published scientific articles and includes the accumulated experience of governments and other parts of society: mechanisms for sharing this knowledge need to be further developed. C. Commitments and priorities The Global Alliance for Chronic Disease is an existing commitment by a number of governments in global health research on NCDs, and it will be important to widen the pool of Governments supporting and contributing funding. A key priority is coordinating the disparate groups of stakeholders, including universities, to address the research gaps and foster emerging researchers. Governments also need to invest in health systems research, in particular to work out how to integrate NCD prevention and control into health service delivery.

11 The presentation of Dr Reddy is available at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_5_research_srinath_reddy.pdf

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WHO has now finalized a three-year project to develop a prioritized agenda for research on NCDs, focusing on prevention and implementation research. This agenda will hopefully guide countries and research institutions in identifying priorities for generating new evidence. WHO's NCD research agenda is a dynamic document that will be reviewed and updated regularly.

Concurrent session 6 Cross government response to NCDs

The sixth concurrent session on the cross-government response to NCDs was chaired by Dr El-Husban Yasin, the Minister of Health of Jordan. The Hon. Tariana Turia, Associate Minister of Health from New Zealand emphasized the need for governments to address the epidemic of noncommunicable diseases, which is impacting on social and economic wellbeing in industrialized and developing countries alike. She underscored the need for cross-sectoral action that empowers families, as well as the need to take concerted and effective action against tobacco and for countries to fully implement the WHO FCTC. 12

The following is a summary of the discussion.

A. Challenges A multi-sector approach is critical to success, but often difficult to deliver sustainably in practice. This applies at both the national and international (UN) level. Educating the public is important as governments are spurred to action when communities advocate for change. There is still work to do in framing NCDs in ways that create a 'win-win' with other government sectors, including local government: it will help to demonstrate that there are short term as well as long term gains. Enforcement mechanisms are a specific area that needs strengthening. It was noted that migrant populations are among the most vulnerable, but this can be politically sensitive. The place of NCDs on the development agenda is also sensitive, but it is clear that they are impacting development and therefore major development agencies need to 'own' NCDs, as they have with HIV/AIDS. Better surveillance will be needed to inform decision making, combined with ongoing evidence generation. The importance of safe food supplies was stressed, and this was identified by some participants as a high priority for cross-sector collaboration. Governments have an important role to play in using instruments such as taxes and regulation appropriately. High level leadership is key to securing a true cross-government approach. B. Outcomes An increased focus on human resources for NCDs will be key, as part of wider health systems strengthening. The focus needs to be on primary health care, including both prevention and treatment. Stronger commitment to global action to address risk factors, for example tobacco, will be needed and governments should set clear expectations in this area.

12 Hon Tariana Turia's address is available online at: http://www.who.int/nmh/events/global_forum_ncd/documents/session_6_turia.pdf

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C. Commitments and priorities It will be important that countries commit to increasing both in-country and external support and resources for NCD prevention and control. Public-private partnerships will need to be part of the response. Finally, agreed targets with clear accountability mechanisms will be essential so that progress can be monitored and reported. VIII. POST-LUNCH PLENARY REPORT BACK The moderator, Mike Wooldridge from the BBC, set the scene for the session by referring to his experience at the 'front-line' as a world news correspondent. This has brought him into contact with those who are delivering health on the front-line, and NCDs present a new dimension. He referred to the disproportionate burden of diseases borne by developing countries, supporting the contention that addressing NCDs goes to the very heart of development and is a matter of justice too. A number of questions remain unanswered and this Forum is an opportunity to start addressing these. The panel consisted of the six rapporteurs from the concurrent sessions, who were invited to report back on the key conclusions of their sessions: these are summarized above. Following the final report back on the Civil Society concurrent session, Mike Wooldridge then moderated an interactive discussion that traversed a wide range of issues. It was clarified that the private sector groups present concurred with the exclusion of the tobacco industry and WHO's policy of not engaging with them. However, later in the discussion, the issue was raised of how to support countries whose economies are highly dependent on tobacco growing. Another contributor suggested that a useful outcome from the high-level meeting would be an agreed 'minimum pack price' for tobacco. The significant role that nurses can play in addressing NCDs was emphasized, including in both policy and practice roles. The importance of ensuring the presence of high level leaders – i.e. Heads of State and Government – at the September high-level meeting was reiterated and participants were urged to work in their own countries to ensure this. The issue of conflict of interest was raised, in particular with reference to the role of the private sector and the food industry. There are risks in involving them, notably that the standards or benchmarks may be lowered if the industry is too involved in the process. This issue had been traversed in the food industry concurrent session, and it was noted that the private sector needs to work hard to earn trust. Pre-diabetes was raised as an example of the need to address early detection and intervention so that reversible 'pre-diseases states' are part of the response. Access to diagnostic tools to support this is an issue in low- and middle-income countries. There was strong support for a call to keep poverty explicit in the response to NCDs is essential, to avoid the so-called 'inverse care' law resulting in those who most need access to care are least likely to receive it.

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There was quite a discussion on the issue of mental health and some support for including it in the current priorities that will be considered at the high-level meeting. This was a theme at some of the regional consultations. The strong links between mental health disorders, including substance use disorders, and other NCDs was emphasized. It was noted that some governments also want to include mental health as part of the current work. Another participant noted that all chronic diseases will benefit both immediately and in the future if we capitalize on the political opportunity afforded by the high-level meeting. Dr Ala Alwan from WHO briefly outlined the key reasons why mental health is not included in the current focus:

− The Global Strategy on NCDs, which dates from 2000, is focused on the four main diseases – cardiovascular disease, diabetes, cancers and chronic respiratory diseases – and these are also the focus of resolutions agreed by Member States related to the UN high-level meeting

− Together these four diseases account for around 80% of NCD-related deaths globally.

− These four diseases share the same main risk factors so prevention approaches are similar, while prevention approaches for mental health disorders

Dr Alwan noted that improvements to health care will benefit both mental health disorders and the priority NCDs: health workforce training, access to essential drugs, health information systems and health financing. The question was raised as to how the global response to NCD prevention and control will be funded – the figure of USD9 billion per annum has been proposed by some commentators. On a related note, access to affordable medicines in low-income countries was identified as a key challenge by several participants. This will require solutions involving both the research-based and generic pharmaceutical industries, but ultimately depends on the prudent policies on the part of governments. Panellists commented that funding will require political leadership that goes beyond ministers of health, and clearly innovative financing mechanism will be needed. Governments will need to identify funding sources, and need to receive a clear message that this would be a very good investment given the potential health care costs averted. It was noted that the private sector is also a significant potential source of funds through appropriate partnerships. There was a call for extending education about NCD prevention to lay people, who are able to undertake quite a lot of the preventive activities, which don't require trained health professionals: public health is everybody's concern. The value of extending education to children was also emphasized.

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Several specific points were made to which the panellists then responded. First, the significance of the relationship between NCDs and ageing was highlighted as a potential way to engage finance and other government sectors. Second, the question was specifically asked about whether NCDs should be included in the Millennium Development Goals (MDGs). Finally, the point was made that, for youth, NCDs are the social justice challenge of their generation much as HIV/AIDS was for the previous one. They have an important and unique contribution to make, not least the use of social media to build momentum. There were different views on whether NCDs should be included in the MDGs. It was pointed out that in the last MDG review in 2010, NCDs were not added to the current MDG indicators. However, there was agreement that an accountability framework with NCD-related goals and targets, and monitoring of progress in achieving them, are essential. There was a call for meaningful patient engagement in decisions about both policy and practice. Patients are well connected to their communities and have an important role to play in raising awareness and improving health literacy. The analogy of the health care process – taking a history, doing the relevant diagnostic tests, making a diagnosis and then treating appropriately – was used to frame the need to clearly convince governments of the need to invest in NCD prevention. The point was made that while the health care system 'owns' diseases, nobody owns primary prevention. This underscores the need to intervene in non-health care settings, in particular in educational institutions. To close, the moderator asked each of the panellists to comment on the lessons from addressing the HIV/AIDs challenge for the current NCD one, and to identify their single top priority for the high-level meeting in September. Mr Wooldrigde noted that at the World Economic Forum in January 2011, the UN Secretary-General Ban Ki-Moon had emphasized the importance of political action and commitment in moving the NCD agenda forward and that this was critical in making progress on HIV/AIDS. Regarding the lessons learnt, it was noted that NCDs are a much bigger problem that HIV/AIDS could ever be so the challenge is even greater. Thinking about NCDs as an epidemic, as happened with HIV/AIDS, is important as it emphasizes the reversibility of the problem. Mobilizing a wide base of support through broad-based partnerships was critical to the success of the response to HIV/AIDS. Public-private partnerships can work, but require a 'grown-up discussion' that we still need to have in the NCD arena. Time-bound and specific commitments were essential for making progress, as was regular monitoring and reporting of progress towards their achievement. It is important not to set different conditions in competition, and a holistic approach is needed that caters to the needs of people who often have both communicable and noncommunicable diseases simultaneously. Finally, innovative resourcing and procurement systems have been developed that provide a template for the NCD response.

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The panellists identified several top priorities for the September high-level meeting. Good leadership and political will are critical – we have the science and evidence, and the political will is now needed to act. In this respect, it is essential to have Heads of State and government present, so that NCDs move beyond being just a health problem. Governments need to invest in surveillance to scope up the size of the problem and the potential impact on their health care systems. Finally, there is enough evidence to begin to respond effectively, and we don't need all the funding available before responding – use the resources available and focus on the top priorities. IX. FINAL PLENARY SESSION The final session of the day commenced with a summary of the key findings and messages by Sir Michael Hirst, President Elect of the International Diabetes Federation. He commenced by commending WHO on convening the Forum and bringing together the wide range of stakeholders present. Sir Michael noted that there is a wide consensus that the full range of stakeholders needs to be engaged in addressing the challenge of NCDs, and they all have a part to play in the lead up to the high-level meeting and in implementing the agreed outcomes. However, an outstanding challenge remains in getting the different stakeholders to work together effectively and sustainably at national and regional levels. All stakeholders – governments, NGOs, the private sector and the public – need to show leadership to ensure they play their part in addressing NCD prevention and control. Effective advocacy from all stakeholders will be essential, including emphasizing that there are short-term wins in tackling NCDs as well as There was wide consensus that whatever outcomes are agreed at the UN high-level meeting on NCDs: these need to measured and monitored and this will require agreed targets for NCD prevention and control. Sir Michael observed that all groups emphasized the importance of strengthening health systems and that NCDs need to be integrated better into health systems and up-skilling health professionals to deal with NCDs. The needs of migrant populations need to be considered and early intervention is vital, for example through identifying managing pre-diabetes. He referred to the call from the private sector for appropriate incentives, which will be important if their contribution is to be sustainable. There is little disagreement that the private sector actors have a role to play, and ways need to be found to better involve them. Proper surveillance is essential to ensure governments know the size of the problem and their progress in addressing it, as is research to improve the implementation of effective interventions. The role of regulation, whether self-regulation or government regulation, had been raised in several sessions.

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The need for identifying resources to achieve the outcomes of the high-level meeting was emphasized. Poverty needs to be explicit consideration. Faith-based organizations are an important source of resources for NCD prevention and control worldwide. Finally, it will be critical to have high-level representation at the September high-level meeting, which will ensure the best possible outcomes. Likewise, it will be vital to mobilize others beyond the NCD sector: NCDs are a major public health challenge, and it is up to everybody to play their part in addressing this challenge. In her closing comments, WHO Director-General Dr Margaret Chan thanked the Russian Federation for its financial and political support for both the Forum and the Ministerial Conference that followed. Dr Chan reiterated that there would be a report on the Forum that would be provided to the Ministers at their Conference on Friday to inform their preparations for the high-level meeting She affirmed the significance of the Forum as an important event to encourage the input of various stakeholders. The Forum is a step to WHO becoming more inclusive, allowing it to hear the different voices and ensure that they are able to inform the decisions of Member States. Dr Chan reiterated that non-communicable diseases can be tackled only by including all parties, including civil society organizations, patients’ organizations, professional groups, and the private sector. The role of the private sector is one that will continue to create debate, given the diversity of views on the topic including among Member States. Dr Chan pointed out that the private sector is not the only group with a potential conflict of interest – all groups have interests but that this does not mean those groups cannot be a part of the discussions, aside from the tobacco industry. The important point is that interests be declared and appropriately managed. Dr Chan reiterated that she guards WHO's independence very carefully. Dr Chan referred to several of the interventions made during the report back session, supporting the work of the Young Professionals Chronic Disease Working Group who labeled NCDs the "HIV of our generation". She also affirmed the role of nurses as key members of the health professional team, and noted that all members of the team are essential. In reference Mental health is a very important issue, including for WHO. In response to the idea of including NCDs in the Millennium Development Goals (MDGs), Dr Chan asked participants why they "would want to board a train that left the station ten years ago". NCDs are important enough in their own regard to warrant a distinct and dedicated initiative. Likewise, we only now have the baseline data required to monitor progress on key indicators, as included in the WHO Global Status Report 2011 released at lunchtime that day.

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Dr Chan confirmed that the Forum was a 'groundbreaking' meeting, and that differences of views are welcome and expected. She finished with three key points. First, that effective action will require "a social movement" and institutions that can use a “whole of government and whole of society approach" to deliver transformative change. She noted the importance of educating girls and providing women with the resources they need to keep their families well. Second, Dr Chan urged participants to support integrated community-based, people-centered primary health care services for health promotion, prevention, early detection and treatment. She emphasized the potential for addressing diabetes and access to effective medicines as an 'early win' and referred to conversations she is having with a range of stakeholders to take this forward. Finally, the Director-General emphasized the importance of institutions playing their roles – including governments, to civil society, the private sector and the media. Her final comment was to underscore breastfeeding as a key to starting children off on the right track in life. X. CONCLUSION The WHO Global Forum assembled over 300 participants from a variety of organizations and perspectives on NCD issues including prevention, disease control, advocacy, as well as those with a broader development interest. Participants were keen to share their perspectives and to contribute to the development of the global response to NCDs, recognizing they all have a significant role to play in future implementation of and advocacy for NCDs. They all wish to be part of the solution. As the first such event, the Forum successfully highlighted many areas of consensus and joint action, as well as those where divergent views remain. There was clear agreement that NCDs are 'everybody's problem' and require concerted action: collaborative working arrangements need to be identified to enable this. While there is a clear need for multisectoral action, with whole of society and whole of government responses, this is challenging given different and competing agendas amongst government ministries. Communities need to be engaged, and this will require improved strategic communication, including through the use of social media, to inform about the burden of NCDs, position it as a key issue, as well as to communicate to local communities what they can do. Challenges also remain in finding ways to enable the various stakeholders to work collaboratively on a national/regional basis in the long term and in unison with national plans. This will require trust to be built among stakeholders and with the public, an essential prerequisite to broader and more productive collaboration. Not surprisingly, there continue to be differing views on how and when the private sector should be engaged, for example in

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infant and young child nutrition, as well as the appropriate balance between voluntary self-regulation and government regulation. Challenges of leadership were also identified and a number of questions remain that need to be considered in the build-up to the high-level meeting:

− How can political will be galvanized so that the different government sectors scale up their response both individually and collectively?

− How can NGOs rise collectively to the challenge of NCDs and generate the social mobilization needed to support political action?

− Will the private sector, including industries that need to change what they current do, act decisively?

− Can we collectively create the environment that will support the public to 'choose' healthier lifestyles and products?

Forum participants indentified a number of important outcomes from the September high-level meeting that would help to move NCD prevention and control forward

− There was broad agreement that NCD prevention and control is critical to national development (health, social and economic) and effective development cannot occur without addressing NCDs.

− The ability to measure and monitor programmes and targets for NCD prevention and control is critical, and should be a focus for discussion. Better epidemiological surveillance of NCDs is critical to demonstrate the extent of the problem and empower government action based on evidence and to monitor progress.

− Health systems strengthening, including adequate and well-trained supply of health worker, should focus on integration across disease areas and particularly on community-based primary health care.

− Implementing the agreed 'best buys', e.g. raising taxes on tobacco and alcohol are key opportunities to reduce risk factors and, potentially, generate revenue that can be used to tackle NCDs: both are in line with FCTC and WHO recommendations. There is very good evidence that they have an effect on reducing consumption of tobacco and harmful consumption of alcohol.

− Appropriate incentives are an important strategy for advancing action to prevent and control NCDs by the public (healthy choices), health professionals, and the private sector.

− Country-specific implementation research is needed yield timely evidence on how to successfully implement the known 'best buys". Ensuring rapid uptake of evidence into policy is key to success in advancing NCDs.

Finally, specific commitments were made by many at the Forum to help scale up both national and global action to prevent and control NCDs. Many NGOs committed to actively supporting NCD prevention and control interventions, as well as developing a social

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movement to support political action. Similarly, there was a range of commitments to increase health and social service delivery by those NGOs involved in these activities. Faith based organizations made a specific commitment to use their enormous reach to advocate for NCD prevention and control, conduct health promotion and education activities and to support communities to respond. A range of private sector actors clearly stated their willingness to play an expanded role in NCD prevention and control. The private sector needs to be part of the solution and it can make a decisively important contribution in addressing NCD prevention challenges. The corporate sector should work closely with governments to support NCD prevention and control by reformulating their products, ensuring responsible marketing, and helping to make essential medicines and technologies more accessible. The private sector has many assets to share, although there is work still to do to find ways to involve them most effectively and appropriately. Participants expressed their satisfaction during and after the Forum at having this opportunity to contribute to the build-up to the UN high-level meeting on NCDs in New York in September 2011. The Forum was an important milestone on the road to both the high-level meeting, as well as WHO's wider move to facilitating broader input into discussions on key global health issues.

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APPENDIX 1: ANNOTATED AGENDA

Objectives:

• Provide an opportunity for a wide range of stakeholders to discuss and share perspectives on the prevention and control of noncommunicable diseases (NCDs)

• Understand expectations, roles and contributions of the different stakeholders in support of the September 2011 UN high-level meeting (HLM) on NCDs and its expected outcomes, as well as activities post the HLM

• Update knowledge and share experience on progress in addressing NCDs including through implementing the Action Plan for the Global Strategy for the Prevention and Control of NCDs

• Promote ways of accelerating the implementation of actions for international and national partners under each objective of the Action Plan

• Mobilize a broader base of stakeholders in support of NCD prevention and control, in particular in developing countries.

Deliverables:

• A short report that could be presented by one or more of the stakeholder groups during the World Health Assembly in May 2011 to support Member States' preparation for the HLM

• Lessons learnt in organizing multi-stakeholder discussion forums • A statement to be delivered to the Moscow Ministerial Meeting representing key

perspectives from the stakeholders.

Wednesday, 27 April 2011 09:00-09:50 Opening plenary and scene setting for the day (Ladoga Hall, Office Tower 2)

The Forum opens with a fifty minute plenary session, commencing with a welcome from the WHO Director-General, Dr Margaret Chan, who sets the scene for the day and the context for the Forum. Dr Veronika Skvortsova, Deputy Minister of Health and Social Development, Russian Federation will welcome participants on behalf of the host country. Finally, Dr Ala Alwan, ADG Noncommunicable diseases and Mental Health, WHO provides an update on

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preparations for the September UN high level meeting on NCDs and outlines the objectives for the following concurrent session.

Speakers − Margaret Chan, Director-General, WHO − Veronika Svortsova, Deputy Minister of Health and Social Development, Russian

Federation − Ala Alwan, Assistant Director-General, Noncommunicable Diseases and Mental

Health, WHO

09:50-10:20 Break 10:20-12:00 Concurrent sessions: Multistakeholder response to the NCD epidemic (Breakout rooms, Office Tower 2) After the morning break, there are six concurrent sessions. Each session focuses on the contribution of a key stakdeholder group to the prevention and control of NCDs, identifying: 4. the key challenges for NCD prevention and control, as they relate to the group or issue 5. the outcomes they wish to see from the Moscow Ministerial Conference and the

September High Level Meeting 6. the commitments/priorities identified as necessary to accelerate progress in addressing

NCDs. The format is a brief (10 minute) presentation to provide an overview of the issues, with brief responses (5 minutes) followed by facilitated discussion on the three key questions. Session rapporteurs will collate and summarise the outcomes of discussions, which will be reported back in post-lunch plenary session. Stakeholder focus for breakout sessions Concurrent session 1 (Selenga) Private sector including pharma, insurance, e-

health, sport Chair

− Eduardo Pisani, Director-General, IFPMA Speaker/Respondents

− Olivier Raynaud, Director, World Economic Forum − Richard Smith, UnitedHealth Chronic Disease Initiative

Rapporteur

− Paul Litchfield, Chief Medical Officer, British Telecom

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Concurrent session 2 (Neva) Food, non-alcoholic beverage and alcoholic

beverage industries Chair

− Jorge Casimiro, Coca Cola, representing the International Food and Beverage Alliance (IFBA)

Speaker/Respondents

− Janet Voûte, Nestlé, representing the IFBA − Hervé Nordmann, Chairman, Industry Council for Development − Will Gilroy, Director of Communications, World Federation of Advertisers − Astrid Williams, Pepsico, representing the IFBA

Rapporteur

− Jeff Sturchio, President and CEO, Global Health Council Concurrent session 3 (Dvina) Health professionals and health services Chair

− David Kerr, President, European Society for Medical Oncology

Speaker/Respondents − Eduardo Cazap, President, Union for International Cancer Control − Mubashar Sheikh, Executive Director, Global Health Workforce Alliance − Liming Li, Vice President, Chinese Academy of Medical Science

− Vladimir Starodubov, Vice President, Russian Academy of Medical Science

Rapporteur

− Peter Eriki, Director Health Systems, African Centre for Global Health and Social Transformation (ACHEST)

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Concurrent session 4 (Ladoga) Civil Society including faith-based and consumer

organizations Chair

− Bertie Squire, President, International Union Against Tuberculosis and Lung Disease

Speaker/Respondents

− Doug Ulman, CEO, LIVESTRONG − Jean-Claude Mbanya, President, International Diabetes Federation − Robert Beaglehole, University of Auckland/'Lancet Group'

Rapporteur − Sania Nishtar, President and Founder, Heartfile

Concurrent session 5 (Angara) Researchers and academia

Chair − Abdallah Daar, Professor of Public Health Sciences, University of Toronto

Speaker/Respondents − Srinath Reddy, President, Public Health Foundation of India

− Roger Glass, Fogarty International Center

− Jane Billings, Senior Assistant Deputy Minister, Public Health Agency of Canada

Rapporteur

− David Matthews, Director, Global Alliance for Chronic Diseases

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Concurrent session 6 (Enesei) Cross government response to NCDs

Chair − Yasin El-Husban, Minister of Health, Jordan

Speaker/Respondents

− Tariana Turia, Associate Minister of Health, New Zealand − Sir George Alleyne, Director Emeritus, PAHO − Irina Nikolic, World Bank

Rapporteur

− Rosie Henson, Department of Health and Human Services, USA 12:00-13:00 Lunch 13:00-14:45 Moderated Plenary Report Back Session (Ladoga Hall, Office Tower 2)

The post-lunch plenary allows the six rapporteurs from each of the concurrent sessions to report back the outcomes of their group's discussion in the morning. Each rapporteur has 3-5 minutes to present the key messages from their group. A guest moderator will then question the rapporteurs and field questions and comments from the floor.

Moderator − Mike Wooldridge, BBC World Affairs Correspondent

Panellists

− Paul Litchfield, Chief Medical Officer, British Telecom − Jeff Sturchio, President and CEO, Global Health Council − Peter Eriki, Director Health Systems, ACHEST − David Matthews, Global Alliance for Chronic Diseases − Rosie Henson, Department of Health and Human Services, USA − Sania Nishtar, President and Founder, Heartfile

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14:45-15:30 Final plenary and summary of key findings (Ladoga Hall, Office Tower 2) Speakers

− Sir Michael Hirst, President Elect, International Diabetes Federation − Margaret Chan, Director-General, WHO

In the final session, the key messages from the day's discussions, including the concurrent sessions and the plenary report-back, will be summarized in readiness for presentation the following day to the Moscow Ministerial Conference. The WHO Director-General will also respond to the discussion and close the Forum.

15:30 Forum adjourns Afternoon tea will be served at the close of the Forum

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APPENDIX 2: WHO Global Forum List of Participants who had registered by 25 April 2011

Dr Hasan ABDUL RAHMAN Director General of Health Ministry of Health MALAYSIA Mr Cary ADAMS CEO Union for International Cancer Control SWITZERLAND Dr Marine ADAMYAN Health and HIV/AIDS Director World Vision International, Middle East, Eastern Europe and Central Asia Regional Office ARMENIA Mr Zlatko ADLESIC Counseillor Embassy of Slovenia in Moscow SLOVENIA Dr Patrick AGHANIAN Chairman, AIPM RUSSIA Dr Kamel AJLOUNI President The National center for Diabetes, Endocrinology and Genetics JORDAN Dr Aram AKOPYAN Executive Director Association Innovative "Pharma" RUSSIA Mr Md Moshaid ALI APS to Honorable Minister Ministry of Health & Family Welfare BANGLADESH Dr Salih AL MARRI Asst. Secretary General for Medical Affairs Supreme Council of Health QATAR Dr Evgeniya ALEKSEEVA Public Health and Social Development Foundation FOCUS-MEDIA RUSSIA

Dr Jasem ALKANDARI Associate Professor Kuwait University KUWAIT Dr Muna AL KUWARI Director of Primary care Department Ministry of Health UNITED ARAB EMIRATES Sir George ALLEYNE Director Emeritus Pan American Health Organization USA Mr Bjørnar ALLGOT General Secretary Diabetes Association NORWAY Dr Easa AL MANSOORI Director of Foreign Relation and International Organizations Ministry of Health UNITED ARAB EMIRATES Dr Mohamed AL-THANI Director of Public Health Supreme Council of Health QATAR Ms Benedikte L. ALVEBERG Senior Adviser Ministry of Health and Care Services NORWAY Dr Lene ANDERSEN Member Danish Association of the Pharmaceutical Industry DENMARK Dr Sylvia ANIE Director Commonwealth Secretariat UK Dr Kezevino ARAM Director Shanti Ashram INDIA

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Mr Nicholas ASTBURY Consultant Ophthalmologist International Agency for the Prevention of Blindness UK Ms Anne Louise AVNSTROEM Head of Section Ministry of the Interior and Health DENMARK Ms Yasmina BADDOU Minister of Health Ministry of Health MOROCCO Mr Øystein BAKKE Secretary Global Alcohol Policy Alliance (GAPA) NORWAY Mr Thirukumaran BALASUBRAMANIAM Geneva Representative Knowledge Ecology International SWITZERLAND Dr Donald BASH-TAQI Medical Doctor Ministry of Health and Sanitation SIERRA LEONE Mr Loyce Pace BASS Director of Health Policy LIVESTRONG USA Dr Nooshin BAZARGANI Secretary World Heart Federation UNITED ARAB EMIRATES Dr Robert BEAGLEHOLE Emeritus Professor University of Auckland NEW ZEALAND Dr Adel BELBEISI Secretary General of Jordan Medical Council Ministry of Health, JORDAN Mr Pierre-Olivier BERGERON Secretary General The Brewers of Europe BELGIUM Mrs Kirstine Vangkilde BERNER Head of Section, Ministry of Foreign Affairs DENMARK

Ms Ana BIDOIS Health Advisor, Associate Minister of Health Ministry of Health NEW ZEALAND Mrs Jane BILLINGS Senior Assistant Deputy Minister Public Health Agency of Canada CANADA Dr Nils E. BILLO Executive Director International Union Against Tuberculosis and Lung Disease FRANCE Dr Ivan BLANARIK Board Member AIPM, NCD Task Force Member AIPM RUSSIA Mr Tamba BORBOR SAWYER Politician Ministry of Health and Sanitatino SIERRA LEONE Dr Jean BOUSQUET Chairman WHO Global Alliance against Chronic Respiratory Diseases FRANCE Ms Sarab BRANCHI Policy Officer Ministry of foreign and European affairs FRANCE Mrs Nancy BROWN CEO American Heart Association USA Ms Stephanie BRUNET Senior Health Analyst Canadian International Development Agency CANADA Dr Fiona BULL Professor, Chair of Global Advocacy for Physical Activity The University of Western Australia AUSTRALIA Mr Bernt BULL Senior Advisor Ministry of Health and Care Services NORWAY

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Mrs Anne-Beatric BULLINGE Diplomatic Officer Swiss Federal Department of Foreign Affairs SWITZERLAND Mr Jorge CASIMIRO Director The Coca-Cola Company/International Food & Beverage Alliance (IFBA) USA Dr Eduardo CAZAP President Union for International Cancer Control (UICC) ARGENTINA Dr Natalia CEBOTARENCO Ecumenical Pharmaceutical Network MOLDOVA Dr Haozhu CHEN Professor Shanghai Institute of Cardiovascular Diseases CHINA Dr Rethy CHHEM Director IAEA/NAHU International Atomic Energy Agency AUSTRIA Dr Oleg CHESTNOV Deputy Director Department of international cooperation, Ministry of Health and Social Development RUSSIA Mrs Michelle CHILDS Director Policy Advocacy Médecins Sans Frontières Access Campaign SWITZERLAND Dr Yong Su CHOE Interpreter Ministry of Public Health DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA Dr Zafrullah CHOWDHURY Community Physician and Health Activist Gonoshasthaya Kendra BANGLADESH Dr Téa COLLINS Executive Director The NCD Alliance SWITZERLAND Dr Abdallah DAAR Professor of Public Health Sciences University of Toronto CANADA

Dr Ponmek DALALOY Minister Ministry of Health LAO PEOPLE'S DEMOCRATIC REPUBLIC Dr Isabella DANEL Associate Director for Program Development Centers for Disease Control and Prevention Center for Global Health USA Ms Maggie DAVIES Executive Director Health Action Partnership International UK Dr Jostein DAVIDSEN Vice-Chairman AIPM RUSSIA Dr Andrey Konstantinovich DEMIN President, Russian Public Health Association (representing World Federation of Public Health Associations) RUSSIA Dr Sylvie DESJARDINS Scientific Director, WHO Collaborating Centre on Chronic Non-communicable Disease Policy Public Health Agency of Canada CANADA Mrs Mirjana DJURANOVIC Senior Adviser for International Cooperation Ministry of Health MONTENEGRO Mr Victor DMITRIEV CEO Association of the Russian pharmaceutical manufactures (ARPM) RUSSIA Dr Phramaha Boonchuay DOOJAI Vice Rector Mahachulalongkornrajavidyalaya University (Buddhist University) THAILAND Mr Eloi A. Maxime DOVO Ambassador Embassy of Madagascar to Russian Federation MADAGASCAR Dr Thomas DREKONJA CEO/Orthopedic Surgeon ORTHOMED PLUS AUSTRIA

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Mr Roland DRIECE Health Attaché to the UN in Geneva Ministry of Health, Welfare and Sport NETHERLANDS Mr Ivan DUBOV Director Department of international cooperation, Ministry of Health and Social Development RUSSIA Ms Alessandra DURSTINE Vice President of Regional Programs American Cancer Society Global Health Department USA Dr Omar EL MENZHI Director of Epidemiology and Disease Control Ministry of health MOROCCO Dr Yasin EL-HUSBAN Minister of Health Ministry of Health JORDAN Ms Vivian ELLIS Senior Special Advisor and Director Centre for Chronic Disease Prevention and Control Public Health Agency of Canada CANADA Dr Ibrahim ELMADFA Director and Professor, Institute of Nutritional Sciences, University of Vienna AUSTRIA Ms Kimberly ELMSLIE Director General Centre for Chronic Disease Prevention and Control Public Health Agency of Canada CANADA Dr Peter ERIKI Director Health Systems African Centre for Global Health and Social Transformation (ACHEST) UGANDA Ms Charlotte ERSBØLL Member Danish Association of the Pharmaceutical Industry DENMARK Dr. Mustapha FEISUL IDZWAN Senior Principal Assistant Director Disease Control Division Ministry of Health MALAYSIA

Dr Mahmoud FIKRI Assistant Undersecretary For Health Policies Affairs Ministry of Health UNITED ARAB EMIRATES Ms Ada FILIP-SLIVNIK Ambassador of Slovenia Emvassy of Slovenia in Moscow SLOVENIA Dr Luiz Augusto GALVÃO Manager, Sustainable Development and Environmental Health Pan American Health Organization (PAHO) USA Dr Vijay GANJU Secretary General World Federation for Mental Health USA Mr Abdoulkader GARAD Health Information System Ministry of health DJIBOUTI Dr Dietrich GARLICHS CEO DiabetesDE GERMANY Dr Francisco GEORGE Director General of Health Directorate General of Health PORTUGAL Ms Amie GIANINO Senior Director Anheuser-Busch InBev USA Mr Will GILROY Director of Communications World Federation of Advertisers BELGIUM Mrs Fiona GODFREY European Regional Tobacco Control Adviser INWAT LUXEMBOURG Mr Christopher GRAY Representative International Organization of Employers USA Mr Nathan GREY National Vice President of the International Affairs Department America Cancer Society USA

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Mrs Julia GRISHCHENKOVA Head of Representative Office in Moscow Deutsche Gesellschaft für Internazionale Zusammenarbeit (GIZ) GmnH RUSSIA Mrs Joanna GROVES Chief Executive Officer International Alliance of Patients' Organizations (IAPO) UK Ms Katherine HAGEN Executive Director Global Social Observatory SWITZERLAND Dr Mark HANSON Director Institute of Developmental Sciences and DOHaD Division University of Southampton UK Dr A.F.M. Ruhal HAQUE Minister of Health Ministry of Health & Family Welfare BANGLADESH Dr Fred HARDINGE Associate Director, Health Ministries Department General Conference of Seventh-Day Adventists USA Dr Sakamoto HARUKA Section Chief, Office of International Cooperation Ministry of Health, Labour and Welfare JAPAN Mr Laurence W. (Larry) HAUSNER Chief Executive Officer American Diabetes Association USA Mr Douglas HAWKINS Vice President, Public Affairs and Policy International Special Dietary Foods Industries (ISDI) SWITZERLAND Dr Mieke HAZES Professor of Rheumatology Bone & Joint Decade 2010-2020 NETHERLANDS Dr Kelly HENNING Director Global Public Health USA Ms Rosie HENSON Senior Policy Advisor, Assistant Secretary of Health Department of Health and Human Services (HHS) USA

Dr Yamamoto HIDENORI Deputy Director Ministry of Health, Labour and Welfare JAPAN Sir Michael HIRST Global President-Elect International Diabetes Federation UK Dr SUNG IL HONG Official Ministry of Public Health DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA Dr Richard HORTON Editor-in-Chief The Lancet UK Ms Leah HSU International Health Analyst U.S. Department of Health and Human Services USA Dr Jianshi HUANG Professor and Dean School of Public Health Peking Union Medical College CHINA Mr Laurent HUBER Director Framework Convention Alliance FCA USA Dr Mark JACOBS Director of Public Health Ministry of Health NEW ZEALAND Mr Syed Hussain JAFRI Chair, International Alliance of Patients Organizations (IAPO) PAKISTAN Dr William Phillip JAMES Public Health Physician International Association for the Study of Obesity UK Dr Eva JANE-LLOPIS Head, NCD and Well-Being World Economic Forum SWITZERLAND Ms Soumaya JDIDI Conseillère au Cabinet de Madame la ministre Ministry of Health MOROCCO

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Dr Garry JENNINGS Director Baker IDI Heart and Diabetes Institute AUSTRIA Ms Shoba JOHN Chair Framework Convention Alliance (FCA) INDIA Dr Anil KAPUR Managing Director World Diabetes Foundation DENMARK Mr Eduard KARYUKHIN Medical doctor-Gerontologist Regional Public Foundation Assistance for the Elderly Dobroe Delo RUSSIA Dr Adachi KAZUHIKO Director-General, Kinki Regional Bureau of Health and Welfare Ministry of Health, Labour and Welfare JAPAN Dr David KERR President, European Society for Medical Oncology Rhodes Professor of Clinical Pharmacology and Cancer Therapeutics at the University of Oxford UK Mr Mohammad KHAIRUL ALAM Executive Director Rainbow Nari O Shishu Kallyan Foundation BANGLADESH Dr A K Azad KHAN President Diabetic Association of Bangladesh BANGLADESH Mr Sandeep KISHORE Chair, Young Professionals Chronic Disease Network USA Dr Harald KISS CEO/Orthopedic Surgeon ORTHOMED PLUS AUSTRIA Ms Rachel KITONYO Project Coordinator Africa Tobacco Control Consortium TOGO Dr Knut-Inge KLEPP Director General, Division of Public Health Norwegian Directorate of Health NORWAY

Mr Ruslan KOKAREV Chief Operations Officer Association of European Businesses in the Russian Federation RUSSIA Dr Mihály KÖKÉNY Chairman WHO Executive Board HUNGARY Dr Alexey KOTOV Technical Advisor World Lung Foundation USA Dr Jana KOTUKHOVA Association of European Businesses in the Russian Federation RUSSIA Dr Manoj KURIAN Program Executive, Health and Healing World Counil of Churches MALAYSIA Ms Hafida LAHIOUEL Senior Advisor Office of the President of the United Nations General Assembly USA Ms Marie-Claude LAMARRE Executive Director International Union for Health Promotion and Education FRANCE Dr Peter LAMPTEY President, Public Health Programs Family Health International GHANA Dr Bjørn-Inge LARSEN Director General for Health, Chief Medical Officer Directorate of Health NORWAY Mr James LEE Vice President Strategy & Regional Affairs GBCHealth USA Mrs Silvana LESCA First Secretary of the Embassy of Uruguay to the Russian Federation Embassy of Uruguay to the Russian Federation URUGUAY

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Dr Liming LI Executive Vice President Chinese Academy of Medical Sciences / Peking Union Medical College CHINA Dr Harald LIPMAN Executive Director International Cardiac Healthcare & Risk Factor Modification (ICHARM) UK Dr Paul LITCHFIELD Chief Medical Officer and Head of Health and Safety British Telecom UK Dr Agima LJALJEVIC Director of Health Promotion Center Institute for Public Health MONTENEGRO Dr Sulaiman LOKMAN HAKIM Deputy Director General of Health (Public Health) Ministry of Health MALAYSIA HE Sylvie LUCAS Ambassador, Permanent Representative to the UN Directorate General of Health Services LUXEMBOURG Mr Marc-Ivar MAGNUS Project Coordinator World Federation of the Sporting Goods Industry (WFSGI) SWITZERLAND Mr Krishna Bahadur MAHARA Deputy Prime Minister and Minister for Health & Population Ministry of Health & Population NEPAL Dr Mustapha MAHFOUDI Head of division of non communicable diseases Ministry of Health MOROCCO Dr William MAINA Head: Division of Non communicable diseases Ministry of Public Health and Sanitation KENYA Dr Alexander MAIOROV Representative of the IDF Europe in Russia, Expert of the Russian Association of Endocrinologists, Endocrinological Research Center of the Ministry of Health and Social Development RUSSIA

Mr Denis MANCEVIC 3rd Secretary Embassy of the Republic of Slovenia in Moscow SLOVENIA Dr Michel MANON Chair NCD Task Force AIPM RUSSIA Dr Dorijan MARUSIC Minister Ministry of Health of the Republic of Slovenia SLOVENIA Dr David MATTHEWS Professor of Diabetes Medicine, Harris Manchester College University of Oxford UK Dr Jean-Claude MBANYA President International Diabetes Federation CAMEROON Mr Jeffrey MEER Special Advisor for Global Health The Public Health Institute USA Mr Viktoras MEIŽIS Head of EU Affairs and International Relations Division Ministry of Health of the Republic of Lithuania LITHUANIA Mr Jorge MEYER Ambassador of Uruguay to the Russian Federation Embassy of Uruguay to the Russian Federation URUGUAY Dr Haakon E.MEYER Professor National Council for Nutrition NORWAY Dr Nathalie MEZGER Physician University Hospital of Geneva SWITZERLAND Dr Orlando MONTEIRO DA SILVA President elect World Dental Federation FDI, World Health Professions Alliance WHPA PORTUGAL Ms Irina MOROZOVA Communications Manager World Lung Foundation USA

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Ms Claire MORRIS Advocacy and Policy Officer Worldwide Palliative Care Alliance UK Ms Caitlin MORRIS-BENDER Director Nike Inc USA Mr Craig MOSCETTI Policy Manager Global Health Council USA Dr Aliaksandr MROCHAK Director, Republican Scientific and Clinical Institute «Cardiology» BELARUS Dr Davron MUKHAMADIEV Regional Health Coordinator The International Federation of Red Cross and Red Crescent Societies Regional Representation in Moscow RUSSIA Mr Matthew MYERS President Campaign for Tobacco-Free Kids USA Mrs Mariam Regina NAMATA KAMOGA Country Manager Community Health & Information Network(CHAIN) UGANDA Dr Hail NIKOGOSIAN Head of the Convention Secretariat Framework Convention on Tobacco Control SWITZERLAND Dr Irina NIKOLIC Health, Nutrition and Population Department The World Bank USA Dr Sania NISHTAR Founder and President Heartfile PAKISTAN Dr Hervé NORDMANN Chair Industry Council for Development (ICD) SWITZERLAND Dr Bo NORRVING Professor in Neurology, Lund University President World Stroke Organization SWEDEN

Mr Patrik NYLANDER Deputy Director Ministry of Health and Social Affairs SWEDEN Dr Peter Anyang' NYONG'O Cabinet Minister Ministry of Medical Services KENYA Dr Gregorio OBRADOR Dean Universidad Panamericana School of Medicine MEXICO Ms Adanma ODEFA Chief Executive Officer Diabetes & Hypertension Help Society NIGERIA Mr Daniel OLESKER Minister of Public Health of Uruguay Ministry of Public Health of Uruguay URUGUAY Ms Princess Nikky ONYERI Director Genera and CEO Forum of African First Ladies Against Breast and Cerical Cacner NIGERIA Mr Mario OTTIGLIO Associate Director, Public Affairs and Global Health Policy IFPMA SWITZERLAND Mr Ruslan OVEZDURDYEV Founder, Foundation "Center for Social Development and Information" RUSSIA Mr Konstantin PEKARSKIY Marketing & Sales Director for HCP Technogym RUSSIA Dr Zoltan PATAKY Physician University Hospital of Geneva SWITZERLAND Mr Greg PATON Policy Manager The NCD Alliance SWITZERLAND Ms Cath PATTERSON Adviser Department of Health and Ageing AUSTRALIA

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Mr David PATTERSON Manager, Health Law Program International Development Law Organization (IDLO) ITALY Ms Rebecca PERL Associate Director, Communications and Special Projects World Lung Foundation USA Dr Valentina PETERKOVA President of the Russian Diabetes Association, Director of the Institute of Children's Diabetes, Endocrinological Research Center of the Ministry of Health and Social Development RUSSIA Ms Vesna-Kerstin PETRIC Counseillor Ministry of Health of the Republic of Slovenia SLOVENIA Mr Bosse PETTERSSON Senior Advisor Ministry of Health and Social Affairs SWEDEN Dr Bounfeng PHOUMMALAYSITH Deputy Director General Cabinet, Ministry of Health LAO PEOPLE'S DEMOCRATIC REPUBLIC Dr Victoria PINKNEY-ATKINSON Chairperson Patient Alliance of Non-Governmental Organisations SOUTH AFRICA Mr Ariel PINO Coordinator of Technical Commissions Activities International Social Security Organization - ISSA SWITZERLAND Mr Eduardo PISANI Director-General International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) SWITZERLAND Mr Fructuoso PITTALUGA Minister of the Embassy of Uruguay to the Russian Federation Embassy of Uruguay to the Russian Federation URUGUAY Ms Natalya PODOGOVA Vice-President, Director Russia and CIS Global Business Coalition on HIV/AIDS, tuberculosis and malaria (GBC) RUSSIA

Mrs Andreja PURKART-MARTINEZ Minister Plenipotentiary Embassy of Slovenia in Moscow SLOVENIA Dr Miodrag RADUNOVIC Ministry Ministry of Health MONTENEGRO Mrs Johanna RALSTON Chief Executive Officer World Heart Federation SWITZERLAND Mrs Cinthya RAMIREZ Manager Global Health Policy IFPMA SWITZERLAND Dr Scott RATZAN Vice President - Global Health Johnson & Johnson USA Dr Salman RAWAF Professor of Public Health, Imperial College London Director of WHO Collaborating Centre for Public Health Education and Training UK Dr Olivier RAYNAUD Senior Director Global Health and Healthcare Sector World Economic Forum SWITZERLAND Dr Srinath REDDY President Public Health Foundation of India INDIA Dr Alma Eunice RENDÓN CÁRDENAS Director-General of International Relations Secretariat of Health of Mexico MEXICO Mr Herb RIBAND Vice President External Affairs International Medtronic SWITZERLAND Ms Yolonda RICHARDSON Vice President International Programs Campaign for Tobacco Free Kids USA Mrs Arnhild Haga RIMESTAD Senior Adviser Norwegian Directorate of Health NORWAY

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Dr Gilberto RÍOS Director-General of Health of Uruguay Ministry of Public Health of Uruguay URUGUAY Dr Rachel RODIN Medical Specialist Public Health Agency of Canada CANADA Dr Eugene RUBERANZIZA Expert in charge of Communicable and Non Communicable Diseases Ministry of Health RWANDA Ms Eva Maria RUIZ DE CASTILLA YABAR Ingeniero Industrial - Especialista en Acción Humanitaria y Economía del Desarrollo ONG Esperantra PERU Ms Patricia RUNDALL Policy Director, Baby Milk Action/IBFAN UK Dr Angelique RWIYEREKA KANYANGE Director-General, Clinical Services Ministry of Health RWANDA Ms Anne Lise RYEL Secretary General Norwegian Cancer Society NORWAY Dr Noorjahan SAMAD Professor of Gynaecology and Obstetrics (Retired) Samad Clinic – Shaheed-e-Millat Road, Karachi PAKISTAN Dr Mohamed Ndongo SANGARE Medecin Epidemiologiste Ministere de la Santé et de la Prevention SENEGAL Dr Luiz Antonio SANTINI Director General Brazilian National Cancer Institute BRAZIL Dr Sirpa SARLIO-LÄHTEENKORVA Ministerial Adviser Ministry of Social Affairs and Health FINLAND Dr Stefan SEEBACHER Head of Health Department International Federation of Red Cross and Red Crescent Societies SWITZERLAND

Dr John SEFFRIN Chief Executive Officer American Cancer Society USA Ms Liga SERNA Deputy of Head of the Division of European Affairs and International Cooperation Ministry of Health LATVIA Dr Leyli SHAMURADOVA Deputy Minister Ministry of Health and Medical Industry of Turkmenistan TURKMENISTAN Dr Vladimir SHIPKOV Executive Director AIPM Russia RUSSIA Dr Abdus Samad SHERA Head, Physician and Diabetologist WHO Collaborating Centre, Karachi PAKISTAN Dr Ksenia SCHEKHOVCOVA Adviser, Department of science, education and staff policy, Ministry of Health and Social Development RUSSIA Dr Gaudenz SILBERSCHMIDT Vice-Director Swiss Federal Office of Public Health SWITZERLAND Mr Bengt SKOTHEIM Adviser The Norwegian Directorate of Health NORWAY Mr Siarhei SKRABETS Deputy Head for Demography and Health Security Section of Scientific Concil Parliamentary Assembly BELARUS Dr Veronika SKVORTSOVA Deputy Minister of Health and Social Development RUSSIA Dr Richard SMITH Director UnitedHealth Chronic Disease Initiative UK Dr Stephen Bertel (Bertie) SQUIRE President International Union Against Tuberculosis and Lung Disease (The Union) UK

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Dr Sylvie STACHTCHENKO Dean, School of Public Health University of Alberta CANADA Dr Vladimir STARODUBOV Vice-President, Russian Academy of Medical Science RUSSIA Dr Jeffrey STURCHIO President and CEO Global Health Council USA Mr Raimondas ŠUKYS Minister of Health Ministry of Health of the Republic of Lithuania LITHUANIA Ms Diane SUMMERS Senior Specialist Advocacy and Public Policy GAVI Alliance SWITZERLAND Mrs Hilde C. SUNDREHAGEN Deputy Director-General Ministry of Health and Care Services NORWAY Dr Bal Krishna SUVEDI Deputy Director General Ministry of Health & Population NEPAL Dr John TEDSTROM President and CEO Global Business Coalition Health (GBC Health) USA Dr Takei TEIJI Director Office of International Cooperation Ministry of Health, Labour and Welfare JAPAN Dr Ghebrehiwet TESFAMICAEL Consultant, Nursing and Health Policy International Council of Nurses (ICN) SWITZERLAND Mr Ng Swee TING Undersecretary, Finance Division Ministry of Health MALAYSIA Dr Nikolay TORCHINSKY Professor Assistant The First Moscow State Medical University RUSSIA

Hon Tariana TURIA Associate Minister of Health NEW ZEALAND Mr Doug ULMAN CEO LIVESTRONG (Lance Armstrong Foundation) USA Dr Andrei USATII Minister of Health Ministry of Health MOLDOVA Dr AKM Jafar ULLAH Deputy Program Manager NCD & Arsenic Directorate General of Health Services BANGLADESH Mr Bard VANDVIK Embassy Secretary Norwegian Embassy Moscow NORWAY Mr Ricardo VARELA Deputy Director of Political Affairs of the Ministry of Foreign Affairs of Uruguay President of the FCTC 5th Conference of the Parties URUGUAY Dr Erkki VARTIAINEN Professor, Assistant Director General National Institute for Health and Welfare FINLAND Mr Maxim VASILEVSKY Corporate Affairs Director CIS MARS Incorporated, International Food & Beverage Alliance (IFBA) RUSSIA Dr Tabaré VÁZQUEZ Doctor, Professor Former President of Uruguay URUGUAY Mr Ignacio VÁZQUEZ Radiologist Embassy of Uruguay URUGUAY Mr Alexander VLADYCHENKO Director General of Social Cohesion Council of Europe FRANCE Mrs Janet VOÛTE Vice President, Global Head of Public Affairs Nestlé S.A. SWITZERLAND

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Ms Judith WATT Strategic Adviser Framework Convention Alliance UK Dr David WEBBER Director-General World Self-Medication Industry (WSMI) FRANCE Ms Charlotte WIBACK Communications Manager NCD Alliance SWEDEN Ms Astrid WILLIAMS Director, Public & Government Affairs PepsiCo Europe GERMANY Dr Martin WISEMAN Medical and Scientific Adviser World Cancer Research Fund International UK

Mrs Janet WITHERIDGE Consultant, Worldwide Brewing Alliance UK Mr Michael WOOLDRIDGE World Affairs Correspondent British Broadcasting Corporation (BBC) UK Dr Anthony WOOLF Professor of Rheumatology Bone & Joint Decade 2010-2020 UK Mr Marc WORTMANN Executive Director Alzheimer's Disease International UK Dr JUN ZHOU Shanghai Institute of Cardiovascular Diseases CHINA

World Health Organization Headquarters Dr Margaret CHAN Director-General Dr Ala ALWAN Assistant Director-General Noncommunicable Diseases and Mental Health (NMH) Dr Timothy ARMSTRONG Coordinator Dr Nicholas BANATVALA Senior Adviser Dr Ashley BLOOMFIELD Partnerships Adviser, NMH Dr Francesco BRANCA Director Department of Nutrition for Health and Development Mr Paul GARWOOD Communications Officer, NMH

Dr Shanthi MENDIS Coordinator, Chronic Disease Prevention and Management Dr Alex ROSS Director, Partnerships and UN Reform Dr Mubashar SHEIKH Executive Director Global Health Workforce Alliance Dr Ian SMITH Adviser to the Director-General Mrs Annemiek VAN BOLHUIS Senior Advisor to ADG Mr Menno VAN HILTEN External Relations Officer NMH

Regional Offices Regional Office for the African Region (AFRO)

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Regional Office for the Americas (AMRO) Dr Carl James HOSPEDALES Coordinator, Prevention and Control of Chronic Diseases Regional Office for the Eastern Mediterranean (EMRO) Regional Office for Europe (EURO) Ms Zsuzsanna JAKAB, Regional Director Dr Franklin APFEL Communication Consultant Mr Karim BENTHAMI Administrative Officer Dr Roberto BERTOLLINI WHO Regional Office for Europe Dr Joao da Silva BREDA Programme Manager Dr Nedret EMIROGLU Executive Manager, Division of Communicable Diseases, Health Security, and Environment Dr Jill FARRINGTON Consultant Dr Gauden GALEA Director, Noncommunicable diseases and environment

Dr Ilona KICKBUSCH Director Dr Lucianne LICARI Executive Manager, Country Relations and Corporate Communication Dr Jose Maria MARTIN MORENO Director, Programme Management Ms Maria MEULENBERGS Executive Manager, Strategic Partnerships Dr Leem MEULENSBERGS Dr Jose Martin MORENO Director Dr Elena SHEVKUN Technical Officer Ms Anita STRANDSBJERG Programme Assistant Dr Agis TSOUROS

WHO Office for the Russian Federation Mr Stanislav ABAIMOV IT assistant Ms Irina ABAYEVA Finance Assistant Dr Luigi MIGLIORINI WHO Special Representative for the Russian Federation Dr Chinara AIDYRALIEVA, Technical Officer Dr Inna BASHINA Interpreter Ms Diana DUGINOVA Programme Assistant Dr Tatiana KOLPAKOVA Liaison Officer

Ms Natalia KONOVALOVA Administrative assistant Ms Rimma KUZNETSOVA Programme Assistant Ms Elena LEVINA Programme Assistant Ms Zarina MANSURKHODJAEVA Administrative Assistant Ms Olga MANUKHINA Programme Assistant Dr Dmitry PASHKEVICH Coordinator, WHO TB Control Programme in the Russian Federation

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Mrs Ilga SNEGOVA Programme Assistant Mr Emanuele TACCONI Administrative Officer Mrs Nataliia TOROPOVA

Tobacco Control Program Coordinator Dr Elena VOVC Technical Officer, HIV programme coordinator Dr Francesco ZAMBON Technical officer

Regional Office for the South-East Asia Region (SEARO) Dr Jai P NARAIN Director, Sustainable Development & Healthy Environments Dr Poonam Khetrapal SINGH Deputy Regional Director Regional Office for the Western Pacific Region (WPRO) Dr Young-soo SHIN Regional Director Dr Cherian VARGHESE Technical Officer NCD Dr Temo WAQANIVALU Technical Officer Nutrition and Physical Activity, Fiji

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APPENDIX 3: Opening remarks at the WHO Global Forum by Dr Margaret Chan, Director-General of the World Health Organization

The rise of chronic noncommunicable diseases: an impending disaster13

Moscow, Russian Federation 27 April 2011

Excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,

The rise of chronic noncommunicable diseases presents public health with an enormous challenge. For some countries, it is no exaggeration to describe the situation as an impending disaster. I mean a disaster for health, for society, and most of all for national economies.

We must not forget that the same so-called “modernization” that contributes to the rise of these diseases is being accompanied by a growing need for chronic care of mental illness. The burdens are numerous.

I would further suggest that the challenge of combating chronic diseases has some unprecedented dimensions.

For centuries, the microbial world has been the biggest threat to public health. Then came the vaccines, the miracle cures, and the gradual improvements in standards of living and hygiene that helped eliminate the diseases of filth.

These were public health matters. This was our domain. This was our job, and we got quite some spectacular results.

The battle to control noncommunicable diseases is a different kind of fight. Our standard job, things like getting essential medicines to people, taking care of them in hospitals, have become so massively demanding and so massively costly that they threaten the solvency of even the wealthiest health care systems.

Everyone agrees that prevention is by far the better option. But in this case, the policies that promote unhealthy lifestyles throughout entire populations are made in domains beyond the direct control of health.

13 http://www.who.int/dg/speeches/2011/global_forum_ncd_20110427/en/index.html

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We can compile libraries full of evidence about the dangers of tobacco and passive smoking, but others have to make the laws for tobacco control and enforce them.

We can tell the world that rates of obesity have nearly doubled since 1980, and we can count the costs to health. But we cannot police the products on the grocery shelves and school lunches or control the fact that the cheapest foods are usually the worst for health.

For many decades, public health has stressed the need for collaboration with other sectors, especially for prevention. For a very long time, these were friendly sectors, almost sister sectors, like education, the environment, water supply, sanitation, and a secure and safe food supply.

Today, many of the threats to health that contribute to noncommunicable diseases come from corporations that are big, rich and powerful, driven by commercial interests, and far less friendly to health.

Forget collaboration with the tobacco industry. Never trust this industry on any count, in any deal. Implement the WHO Framework Convention on Tobacco Control. Doing so can avert around 5.5 million deaths each year at a cost, in a low-income setting, of less than 40 cents per person. There is no other “best buy” for the money on offer.

People do not need to smoke, but they do need to eat and drink. Today, more than half of the world’s population lives in an urban setting. Slums need corner food stores that sell fresh produce, not just packaged junk with a cheap price and a long shelf-life.

Cities need the kind of design that encourages people to walk or cycle and enjoy physical exercise. Children need safe places to play. Patients need essential medicines, packaged and priced to encourage compliance.

Here is a question I would like to ask the food and beverage industries. Does it really serve your interests to produce, market, globally distribute, and aggressively advertise, especially to children, products that damage the health of your customers? Does this make sense in any mission statement with a social purpose?

We know that these industries are not homogenous. Some are taking measures to reformulate their products to reduce fat, sugar, and salt content and to modify their marketing practices. These are most welcome trends.

Ladies and gentlemen,

I have a final point. I strongly believe that the rise of chronic diseases calls for some serious thinking about what the world really means by progress.

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Economic development and health development are not at all the same thing. Economic growth improves health only when the right policies are in place, policies that explicitly consider the consequences for health.

Diabetes, which is closely associated with obesity and urbanization, is already consuming nearly 15% of the national health budgets in some countries. Prevalence is skyrocketing in rich and poor countries alike.

What is the net gain if the benefits of modernization and economic growth are cancelled out by the costs, like medical bills, lost productivity, and premature death, of a preventable disease?

Unless they wake up, and take a hard look at policies across-the-board, some countries may very well see that the benefits of economic progress are quite literally cut up and devoured by a knife and a fork.

Rest assured, in this day and age, ever more sophisticated and costly medicines, devices, and technologies will not be able to save the situation. They will not avert an impending disaster. Only smart, farsighted policies can do this.

Thank you.

© World Health Organization, 2011. All rights reserved. The following copyright notice applies: www.who.int/about/copyright This report does not represent an official position of the World Health Organization. The World Health Organization does not warrant that the information contained in this discussion paper is complete and correct and shall not be liable for any damages incurred as a result of its use. The designations employed and the presentation of the material in this discussion paper do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this report. However, this report is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the report lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Unless specified otherwise, the data contained in this report are based on the WHO Global Status Report on Noncommunicable Diseases 2010. Additional information is available at http://www.who.int/nmh/publications/ncd_report2010/en/index.html

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